signs of retinal diseases - auckland · signs of retinal vascular disease. lens • vascular...
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Signs ofRetinal Diseases
Dr Monika Pradhan Dr Tahira MalikConsultant Ophthalmologists
Case Scenario LinksSigns of Retinal Diseases
• Annual eye screen for patient with diabetes (Oph11)
• Gradual deterioration in visual acuity over time (Oph07)
• Sudden painless loss of vision (Oph04)
• Type 2 diabetes mellitus (Endo11)
Blood Supply of the Retina
3
•CRA - real artery•atherosclerosis•AV crossings•capillary-free zone –
foveal avascular zoneRetinal artery
Choroid
400 µm
Signs of Retinal Vascular Disease
Lens
• Vascular changes – arteriolosclerosis, AV crossing changes, venous tortuosity
• Microaneurysms
• Haemorrhages
• Hard exudates
• Cotton wool spots
• Neovasclarisation
Vessel Wall Changes
Normal
Silver wiring of arterioles
Copper wiring of arterioles
Arteriolar attenuation
AV crossing changes
Vascular Changes
AV crossing changes
Venous dilatation and tortuosity
Microaneurysms
• Tiny round red dots
• In inner nuclear layer
• Saccular outpouchingsfrom vessels due to lack of pericytes
Retinal Haemorrhages
Appearance Localisation Aetiology
• Dot & blot haemorrhages – middle compact retinal layers –diabetic and hypertensive retinopathy
• Flame-shaped haemorrhages – superficial nerve fibre layer –vein occlusion
• Pre-retinal haemorrhages – between posterior hyaloid face and retina – trauma, Valsalva manouvre, neovascularisation
Dot and blot haemorrhages Flame shaped haemorrhages Pre retinal haemorrhage
Retinal Haemorrhages- Roth Spots
• Endocarditis• Anaemia• Haematological
diseases
Hard Exudates
Lipid deposition
Outer plexiform layer
Abnormal vascular permability
Circinate (circular) pattern
Macular star
Hard Exudates
Cotton Wool Spots
• Ischaemic infarction• Nerve fiber layer• Axoplasmic transport defect
• Diabetes• Hypertension• SLE• Leukemias• Infective - HIV
Neovascularisationhypoxia ⇒ vasoformative factors ⇒ neovascularisation• in the retina NVE• on the optic disc NVD• on the iris NVI / rubeosis iridis• in the angle NVACauses:• Diabetes• Retinal vein occlusion• Retrolental fibroplasia• Sickle-cell disease• Inflammatory diseases
Retinal neovascularisation
Iris neovascularisation
Image used with patient permission
Occlusive Vascular Diseases: Signs
Venous occlusion:• Dilated venules• Haemorrhages• Oedema
Occlusive Vascular Diseases Signs
Occlusive Vascular Diseases Signs
Occlusive Vascular Diseases SignsRetinal arteries occlusion:
• constricted arterioles• column interruptions• retinal oedema• cherry red spot• visible emboli
Occlusive Vascular Diseases Signs
Occlusive Vascular Diseases Signs
Degeneration/dystrophy signs
• Drusen• Atrophy• Pigmentation• Scarring
Result of diseaseor Iatrogenic e.g. laser scars
Degeneration/dystrophy signs
• Drusen• Atrophy• Pigmentation• Scarring
Result of diseaseor Iatrogenic e.g. laser scars
Degeneration/dystrophy signs
• Drusen• Atrophy• Pigmentation• Scarring
Result of diseaseor Iatrogenic e.g. laser scars
Degeneration/dystrophy signs
• Drusen• Atrophy• Pigmentation• Scarring
Result of diseaseor Iatrogenic e.g. laser scars
Degeneration/dystrophy signs
• Drusen• Atrophy• Pigmentation• Scarring
Result of diseaseor Iatrogenic e.g. laser scars
Degeneration/dystrophy signs
• Drusen• Atrophy• Pigmentation• Scarring
Result of diseaseor Iatrogenic e.g. laser scars
Elevations of the Retina
sub
Total RetDet.
• by fluid – retinal detachment• by solid mass - tumours• Choroidal neovascularisation
Choroidal melanoma
Choroidal neovascularisation (CNV) – with subretinal haemorrhage
Fluorescein angiogram – showing large CNV at macula
The Macula
• Oedema
• Drusen
• Atrophy
• Scarring
• Pigmentation
Cystoid macular oedema – (CMO/CME) petalloid appearance on FFA
Drusen and atrophy Atrophy and pigmentation
Signs of Inflammation-Posterior uveitis
• Vitreous opacities, cells, snowballs• Choroiditis – deep yellow or grey lesions• Retinitis – white cloudy lesion with obscuration of
retinal vessels• Vasculitis – periphlebitis (veins) or periarteritis –
fluffy haziness around blood column• Granlomas – choroidal or preretinal
Vitritis
Multifocal choroiditis
Retinitis
Granulomas
Self-Assessment:retinal diseases
(All diagnoses covered in preceding PPt)
The EndMaterial contained in this lecture presentation is
copyright of The Department of Ophthalmology, New Zealand National Eye Centre, University of Auckland, and should not be reproduced without first obtaining
written permission